WHO GOES TO THE DOCTOR

Abstract

Preventive health services are vital to child development, but little is known about the family and child factors that explain variation in preventative care visits throughout childhood. This study examined the associations between family and child factors and parents’ reports of preventative care visits at ages 1, 3, 5, 9, and 15. I analyzed data from the Fragile Families and Childhood Wellbeing Study, which covers the period 1998-2017. Results showed that children’s exposure to well-child visits varied over time: 99% (age 1), 97% (age 3), 96% (age 5), 91% (age 9), and 90% (age 15) of children had a preventative visit. Results from multivariate logistic regression models demonstrated that factors associated with higher odds of well-child visits varied by child age. At ages 3 and 5, having a US born mother is associated with higher likelihood of a well-child visits relative to having a foreign born mother. At ages 5, 9, and 15, black children are more likely to experience a well-child visit relative to white children. At ages 9 and 15, having health insurance is positively associated with well-child visit attendance and increases in importance with the age of the child. I find that children in Medicaid expansion states are more likely to experience a well-child visit at age 15 than those in non-expansion states; however, this was also true in a pre-expansion period, suggesting that pre-existing differences in preventative care in Medicaid expansion, rather than Medicaid expansion itself, account for this finding. This study has important implications for children’s use of preventative services over the course of their first 15 years, and suggests that increasing preventative care visits requires attention to distinct risk factors at different parts of the life course.